Inspection on 31/10/07 for West Avenue

This inspection was carried out on 31st October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

West Avenue 19/01/07

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 West Avenue West Avenue 32 West Avenue Pennsylvania Exeter Devon EX4 4SD Lead Inspector Ms Rachel Fleet Announced Inspection 31 October 2007 9.35 West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Avenue Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) West Avenue 32 West Avenue Pennsylvania Exeter Devon EX4 4SD 01392 270760 01392 270872 sdtickner@moduscare.com www.moduscare.com Modus Care Limited Simon De Fraine Tickner Care Home 6 Category(ies) of Learning disability (6) registration, with number of places West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2007 Brief Description of the Service: ‘West Avenue’ is registered to provide residential care for up to six adults below retirement age, who have learning disabilities. Nursing care is not provided. Modus Care (the private company that own West Avenue) aim to provide support to people with Autistic Spectrum Disorders (ASDs), and associated conditions, who require high levels of support. However, no-one has lived at the home for a year, and Modus Care intend that it will remain unoccupied, as they consider the future of the premises. The home is a large detached house in a residential area, about half a mile from the centre of Exeter and adjacent to parkland. It has an enclosed, mostly paved, garden, with an off-road parking area at the front of the property. Accommodation is on two floors, the first floor being accessed only by stairs. There are six single bedrooms, all with en suite shower and toilet. On the ground floor, there are two lounge areas, a dining room, a kitchen, laundry area, the office, and a staff room. Also on the ground floor is a shower wet room, with a toilet, which would be accessible to someone who uses a wheel chair. There is a bathroom upstairs. Fees are charged according to individuals’ needs assessments and agreed with funding bodies such as local authorities. Inspection reports will be supplied by the service with their Statement of purpose and Service users’ guide. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Although we have been told that the home is to remain unoccupied, it is still a registered service and as such the registered owner could admit someone to the home if they wished to. We thus carried out this ‘key’ (main) inspection, which is required by legislation for any registered service. Since the home is unoccupied, we contacted the registered manager a day in advance to arrange to meet at the property for the site visit. This lasted two hours, which included a tour of the home. Simon De Fraine Tickner, the manager, had previously completed a questionnaire from us about the current service. We looked at some documentation, including policies, as well as some relating to care planning, quality assurance, and health and safety. Information thus gained and gained from communication about the home since the last inspection (in January 2007) is included in this report. There are good underpinning systems in place for the core standards relating to ‘Choice of home’, ‘Individual needs and choices’, ‘Lifestyle’, and ‘Personal Healthcare support’. However, the effectiveness or outcomes of these systems could not be assessed in the absence of anyone using the service and in the absence of any staff. Hence several of these core standards have been scored as ‘2’ – standard almost met – with an overall rating of ‘adequate’ for these sections. We will carry out another inspection should anyone move into the home, to ensure that requirements have been addressed and individuals’ needs are being met. What the service does well: What has improved since the last inspection? What they could do better: Although there is information about the home, it should be kept up-to-date to help people make a fully informed choice about where to live. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there is information about the home, it is not sufficient to help people make a fully informed choice about where to live. The home has a thorough approach to assessing potential residents. This will help to make sure that, if someone chooses to move into West Avenue, their needs and goals will be known, with support provided to help them meet their needs and achieve their goals. EVIDENCE: The manager was aware the home’s Statement of Purpose and Service User Guide need updating to reflect the current situation at the home (the staff situation, etc.), although some of the information in them would be helpful to prospective residents and their supporters. We saw staff were expected to go through the information provided with people, explaining it to them as necessary and record when this had been done. No-one has been admitted to the home for a year. However, the manager described the preadmission process he has used in other Modus services, which he would use if approached regarding prospective residents for West West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 9 Avenue. This process usually takes 3-6 months, thus the home cannot accept emergency admissions. It would include visiting the person, as well as speaking with their current carers or supporters, including medical and social care staff - using information gathered over time to identify and assess their needs in detail. The person is invited to visit the home if this would be helpful to them. The assessment also considers any impact on others who may live with the prospective resident, before deciding to offer admission. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has systems, which if put into practice, will help to ensure that peoples’ needs, goals and preferences will be identified together with any risks to their safety and/or independence, and responded to appropriately. However, the outcome for individuals cannot be verified whilst there are no service users. EVIDENCE: A sample care plan seen was very detailed. The format encourages clear identification of individuals’ needs and goals, interventions or support required, and who is responsible for these. The user of the planning system is also prompted to consider and record any crisis/contingency plans, reviews done and when reviews are next due, helping the reader to see how current the information is. There is also evidence of an expectation that the plan will be shared with the person to whom it relates. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 11 We discussed with the manager that the language used in the sample documents seen could be more person-centred, to increase a sense that the care plan is the individual’s document also rather than the staff’s, and of a more balanced partnership between individuals and staff. The manager spoke about the importance of communication, with further regard for promotion of choice and enabling people to make decisions. Staff would receive extra training (in signing, for example) - so as to be able to inform and support individuals appropriately. And advocates would be involved in reviews of individuals’ care, if necessary. The home has access to specialist advice on capacity, to ensure peoples’ rights are upheld as the service complies with the Mental Capacity Act. There is documentation on which to record capacity assessments and ‘best interest’ decision-making. In relation to this, the manager has been looking into how people’ finances are managed (whether they manage their own bank account, etc.), to ensure a consistent approach. An example of the home’s system for recording and assessing risk was seen. It considered and clearly identified risks to the safety of various individuals or groups, in relation to certain outings in this case, and gave strategies to minimise the risks identified. This included multidisciplinary involvement where risks were relatively high. The manager confirmed such risk assessments are kept with the relevant part of a person’s care plan, so staff would be fully informed. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 – 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The philosophy and intentions of the home, if followed through, will promote individuals’ healthy development and fulfilment, although the outcome for individuals cannot be verified whilst there are no service users. EVIDENCE: The manager said that the home is not planned as a “home for life” but as a step towards greater independence for those who move in. He gave examples from his recent experiences, where physiotherapists or occupational therapists have been involved to help people enjoy a more fulfilling life (in other Modus Care services). He also spoke of people who have attended a college, undertaken voluntary work, or who have had a vehicle for their sole use. He confirmed the service would provide staff to support people so they can benefit from such experiences and from familiar or new relationships. People would be West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 13 encouraged to shop and cook for themselves, do their own laundry and cleaning, for example, as would be identified in their individual care plans. The service would usually aim to provide a balanced diet over a week, thus including occasional take-aways as well as fresh fruit and vegetables. Menus would take into account seasonal variations. People who live at the home would be encouraged to use the dining room, staff eating with them; but it was understood that some people might prefer to eat alone. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 – 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s policies and multidisciplinary approach will help to ensure people living at the home receive the support and health care they need, although the outcome for individuals cannot be verified whilst there are no service users. EVIDENCE: The manger said that people would be supported to register with a local GP, and links would be made with local learning disabilities health and social services team. He also said that Modus Care employs a “behavioural specialist”, to advise staff on how to respond to behaviour that challenges them or others. He confirmed that if someone moved to the home from another county, the home would require confirmation from that county’s authorities that handover of responsibilities has been agreed with Devon health and social services authorities. There are secure facilities for medication storage, though the manager confirmed no medications were at the home at the time of our inspection. An updated, comprehensive medication policy for the home was seen - including West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 15 guidance on self-administration by individuals, and action to take should staff make administration errors, for example. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable people to make complaints and to protect them. However, staff will need to be better informed to assure people living at the home that they will be properly safeguarded. EVIDENCE: There is a written complaints procedure, in a standard format, which would be explained to people when staff discussed the Service User Guide with them. The manager agreed to update our contact details. A form is available for people to complete if they wish to make a complaint or for staff to complete if they receive a complaint. Quality assurance checklists were seen to include a section on the availability of the complaints procedure and other related matters. We have not received any complaints about the service. The manager said staff induction included training on safeguarding. It was not clear however that this included local procedures for reporting concerns, which the manager was not fully aware of either. Recruitment procedures have been altered, giving the registered manager more information about prospective staff (rather than staff at the company’s office dealing with some aspects) - thus ensuring he can better ensure the suitability of anyone employed in future. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides adequate private and shared accommodation, although attention is needed before it is liveable in - to ensure people have a homely, clean and well-maintained environment that supports their right to choose where and how they spend their time. EVIDENCE: The home has two lounge areas (one large, one small), a dining room, a domestic kitchen with a separate food preparation area, a laundry, and a toilet/ shower room on the ground floor. The home has not been cleaned recently, and carpet in the main lounge is stained and unsightly. The ceiling over the stairs has water damage visible, and a small area of wall is damaged in the laundry. There is a paved, secure garden area that has level access from the house, but which would need attention to make it a pleasant area to use. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 18 Bedrooms are all for single occupancy, each with en suite shower and toilet facilities, and bedroom doors can be locked by the occupant if they wish. They are not all fully furnished at present. Bedrooms can only be accessed via the stairs, meaning people with restricted mobility could not live at this home. In the process of registering this service, the Commission required that door locks on the front door and on some communal rooms should be changed/removed – so they could not be used to prevent people from leaving the home when they chose, or from moving freely around the home. This has not been done yet. The manager confirmed in the pre-inspection information provided as well as during our visit that this, along with all maintenance and cleanliness matters, would be addressed before anyone moved in. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): None – no staff are employed. The Registered Manager understands the service must meet these standards should any staff be employed in future, to ensure any people living at the home are supported by suitable and competent staff. EVIDENCE: None – no staff are employed, because the registered provider does not intend admitting anyone to this home. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements for managing, assuring the quality and safety of this service need to be developed and fully implemented before prospective residents can be assured they will receive a safe, high standard service. EVIDENCE: The Commission has registered Simon Tickner as the manager of this service, since the last inspection. He is an experienced manager having previously managed a care home for people with learning disabilities. He has achieved a diploma in Social work and the Registered Managers Award. Whilst the home has been unoccupied, he has been involved in managerial responsibilities within the Modus Care organisation. He agreed to consider how he might update his knowledge of local safeguarding procedures. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 21 We looked at some of the home’s systems for quality assurance. This is based on checks carried out either daily, weekly or monthly depending on the issue. The system seen covered areas such as care planning and reviews of maintenance checks. A monthly management report would be produced by the manager for his line manager. We also discussed how people using the service would be consulted, to ensure their views underpin any review, development or improvement of the service. The manager said views are obtained at weekly service user meetings, and in writing prior to six-monthly care reviews, when people are asked about various aspects of the service and their care (such as meals, individual’s daily routine, and staff) before meeting for the review. The fire log showed that fire safety systems have been serviced twice this year, the last date being June 2007. An electrical wiring safety certificate dated February 2004 was seen at the last inspection. A pest control company has been monitoring the premises. Checks for Legionella bacteria in the water system had not been carried out recently, so would have to be done before anyone moved into the home, as would various other checks to ensure the environment is safe should anyone be at the home in future. Prior to the opening of the home a fire officer from Devon Fire and Rescue service visited the home and issued a letter indicating that arrangements regarding evacuation are not satisfactory. The manager confirmed the service would address any fire safety matters should an admission to the home be likely, to meet their obligations under Fire Safety Risk Assessment (Residential Care Premises) 2006 guidance. This was to include a review of the home’s fire risk assessment, with additional consideration of the individual needs of each person living at the home in future. He also said there had been some confusion about the functioning of a fire exit door, and confirmed that in fact the door does becomes operable when the fire alarms are triggered. West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 N/A 32 N/A 33 N/A 34 N/A 35 N/A 36 N/A CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 2 X X 2 X West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 6 Requirement To make sure that there is current and accurate information about the service offered, you must — (a) Keep under review and, where appropriate, revise the statement of purpose and the Service user’s guide; and (b) Notify the Commission and service users of any such revision within 28 days. Timescale for action 30/11/07 2 YA24 23 (1) (2) To make sure that people living 31/01/08 at the home are able to move freely around and out of the home, internal door locks on communal room doors should be removed and the front door lock should be changed, to make sure that people cannot be locked in against their will. This requirement must be met within the timescale given or before anyone moves into the home whichever comes first. This requirement is outstanding from the last West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 24 inspection. 3 YA42 23 (4) To make sure that people living at the home are properly protected from the risk of fire, the home’s arrangements for preventing, detecting and escaping fire should meet with the standards expected by the local fire authority. Action should be taken to achieve compliance with current fire safety legislation, including that the Home’s own fire risk assessment must be reviewed and acted upon as needed, and seeking advice from Devon Fire Safety Authority. Written confirmation that this has been done should be provided to the Commission. This requirement must be met within the timescale given or before anyone moves into the home whichever comes first. This requirement is outstanding from the last inspection. 4 YA42 13(4) To make sure that people 31/01/08 moving into the home are safe, the registered person shall ensure that — (a) All parts of the home to which they have access are, so far as reasonably practicable, free from hazards to their safety; (b) Any activities in which they participate are, so far as reasonably practicable, free from avoidable risks; and (c) Unnecessary risks to their health or safety are identified DS0000067266.V350792.R01.S.doc Version 5.2 Page 25 31/01/08 West Avenue and so far as possible eliminated. This includes risks related to Legionella, gas appliances, electrical equipment, outdoor areas, unrestricted windows, etc. This requirement must be met within the timescale given or before anyone moves into the home whichever comes first. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA23 Good Practice Recommendations To help ensure all staff (including the manager) know how best to protect people from abuse, they should all receive training about the recognition and reporting of abuse of vulnerable adults. Before people move in, the home’s premises should be safe and well maintained, meeting peoples’ individual and collective needs in a comfortable and homely way. Before people move in, the premises should be clean and hygienic, with systems in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. To make sure that people living at the home benefit from a service that provides them with the support they need to the highest standards possible the quality assurance system should be implemented as soon as the home is occupied. 2 3 YA24 YA30 4 YA39 West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI West Avenue DS0000067266.V350792.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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